Provider Demographics
NPI:1508864463
Name:SAVANNAH OUTPATIENT FOOT AND ANKLE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SAVANNAH OUTPATIENT FOOT AND ANKLE SURGERY CENTER, LLC
Other - Org Name:SAVANNAH OUTPATIENT FOOT AND ANKLE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:912-356-8440
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:SUITE 7B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2632
Mailing Address - Country:US
Mailing Address - Phone:912-356-8440
Mailing Address - Fax:912-356-8439
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:SUITE 7B
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2632
Practice Address - Country:US
Practice Address - Phone:912-356-8440
Practice Address - Fax:912-356-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025-291261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111042ASCBMedicare ID - Type Unspecified
GA=========Medicare UPIN